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Sustained inflation versus positive pressure ventilation at birth: a systematic review and meta-analysis
  1. Georg M Schmölzer1,2,3,
  2. Manoj Kumar1,2,
  3. Khalid Aziz1,2,
  4. Gerhard Pichler1,2,3,
  5. Megan O'Reilly1,2,
  6. Gianluca Lista4,
  7. Po-Yin Cheung1,2
  1. 1Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  2. 2Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  3. 3Department of Paediatrics, Medical University Graz, Graz, Austria
  4. 4Division of Neonatology, ‘V Buzzi’ Children's Hospital—ICP, Milan, Italy
  1. Correspondence to Dr G M Schmölzer, Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, Alberta, Canada T5H 3V9; georg.schmoelzer{at}


Context Sustained inflation (SI) has been advocated as an alternative to intermittent positive pressure ventilation (IPPV) during the resuscitation of neonates at birth, to facilitate the early development of an effective functional residual capacity, reduce atelectotrauma and improve oxygenation after the birth of preterm infants.

Objective The primary aim was to review the available literature on the use of SI compared with IPPV at birth in preterm infants for major neonatal outcomes, including bronchopulmonary dysplasia (BPD) and death.

Data source MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, until 6 October 2014.

Study selection Randomised clinical trials comparing the effects of SI with IPPV at birth in preterm infants for neonatal outcomes.

Data extraction and synthesis Descriptive and quantitative information was extracted; data were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I2.

Results Pooled analysis showed significant reduction in the need for mechanical ventilation within 72 h after birth (relative risk (RR) 0.87 (0.77 to 0.97), absolute risk reduction (ARR) −0.10 (−0.17 to −0.03), number needed to treat 10) in preterm infants treated with an initial SI compared with IPPV. However, significantly more infants treated with SI received treatment for patent ductus arteriosus (RR 1.27 (1.05 to 1.54), ARR 0.10 (0.03 to 0.16), number needed to harm 10). There were no differences in BPD, death at the latest follow-up and the combined outcome of death or BPD among survivors between the groups.

Conclusions Compared with IPPV, preterm infants initially treated with SI at birth required less mechanical ventilation with no improvement in the rate of BPD and/or death. The use of SI should be restricted to randomised trials until future studies demonstrate the efficacy and safety of this lung aeration manoeuvre.

  • Infant
  • Newborn
  • Delivery room
  • Neonatal Resuscitation
  • Positive Pressure Respiration
  • Sustained inflation

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